Community Involvement

At which school are you currently enrolled in an EMT course? (Must be currently enrolled)

School

Address

City

State

Zip Code

Course Name and Number

Course Instructor Name

Date of Enrollment (mm/dd/yy)

Anticipated Date of Completion (mm/dd/yy)

Attach proof of enrollment

Reference/Letter of Recommendation

Reference;p>

Name

Relationship to you

Attach letter of recommendation

Essay

After reflecting on the background of Christopher Meadows, please write a brief statement in the space below (not to exceed 250 words) that answers the questions “Why do you want to be an EMT, and why do you feel you should you be awarded the Christopher Meadows EMT Scholarship?”

Updload Essay here:

Type your essay or paste it here:

Special Considerations/Hardships (200 words)

Declaration

By inputting your name below you certify that all the information provided in this application is accurate to the best of your ability.